Apply for cover.

Complete the form carefully. Submission is not proof of active cover.

POLICY APPLICATION

Apply to cover up to
14 people.

This BM Financial Services application captures the main member, spouse, dependants, beneficiary, selected benefits, payment mandate, advice confirmation and declarations.

Important security noticeSubmitting registers a pending application in BM One for staff review and creates an individual Pay@ payment number. Main-member identity and contact details are retained for authorised policy administration and Pay@ setup; bank-account fields are excluded. An application is not proof of active cover.

Membership ApplicationMain member + spouse + up to 12 dependants

No-waiting-period campaign route

Application route

CAMPAIGN WINDOW CLOSED TODAYNext window: 25 October 2026Month-end campaign — day 25

The ordinary application remains available. The special no-waiting-period route will automatically become selectable on verified SASSA payment days, the 15th for government employees, and the 25th, 30th and 31st where those dates exist.

Entry-age eligibility

Main member age band

Standard new-policy entryNew standard policies accept applicants up to and including age 84, subject to the selected product and full policy terms.

Section A - Product and benefit selection

ProductMembership / age optionCalculated monthly premium

Membership numberPreferred debit-order daySales representative

How did you hear about us?

Premiums and benefits are reproduced from the supplied brochure and approved product instructions. Three months waiting period applies to standard natural-cause claims unless written product or campaign terms state otherwise. An approved campaign route is assessed under its specific written campaign terms. No premium, no cover. Accidental-death treatment, eligibility, exclusions and commencement remain subject to the accepted policy wording.

Section B - Main member details

TitleInitialsGender

Full namesSurnameID / passport number

Date of birthCountry of residenceNationality

Country of birthOccupationPostal code

Cell numberWork numberEmail address

Residential address

Section C - Spouse details

TitleInitialsGender

First namesSurnameID / passport number

Date of birthAge

Section D - Dependants - up to 12

Add each dependant and follow the selected product rule. Occupational plans include only the spouse and/or up to six children stated in the selected option. After Tears and Artist use age-based additional-member premiums; Cleansing costs R120 per person; Barber & Stylist costs R25 per person; and Fashion Cover includes a maximum family of eight with no person aged 85 or above. Other plans use the published extended-member table.

Dependant 1+

Full names and surnameRelationship to policyholderID / passport number

Date of birthMember classificationAdditional member age band